Registration - CREW Panama 2020

Registration - CREW Panama 2020

May 29 - April 2
To complete the registration you need your documents to upload, and the ability to pay at the end with Paypal. Feel free to take a look at the form, it's pretty simple, but we receive no information from you until the fee has been paid.
Full Name*

PrefixFirst NameLast Name
Do you speak Spanish*

YesNoA little
The Panamanian Govt requires ALL of the following, and you cannot send us your application unless all 4 are uploaded..

PDF, JPEG, JPG or PNG format only
A copy of your diploma / certificate showing graduation from Chiropractic College*

Browse Files

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A copy of your current license to practice chiropractic*

Browse Files

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A copy of your passport open to the personal details page*

Browse Files

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A copy of your CV (yes we know most of you dont have this, but its a govt requirement, see the notes below)*

Browse Files
Create a letter with your name and contact details, llist your high school and date of graduation. List any college or university courses. List where you have worked. Cancelof
Your Contact Details
Name of your practice / where you practice (main practice when multiple)*
Practice Address*

Street Address

If you need more space for address

CityState / Province

Postal / Zip CodeCountry
Contact Cell/Mobile Phone Number WITH country code eg 1 957 226 1283*

CountryPrefixPhone Number
E-mail - this is where all updates will come to, so make sure you check it*
DC: The T-shirts fit standard sizing, please select best fit*
Non DC Partner

PrefixFirst NameLast Name
Non DC Partner: Do you speak Spanish

YesNo
Partner: The T-shirts fit standard sizing, please select best fit
Travelling partner / Family : please describe your trip intentions.
Hotel rooms in Panama will need to be shared. If known who you want to share with, please write roommate's name.
Credit Card Details are required to reserve a hotel room. No charge will be made against it until you arrive.*
Expiry Date*
Format xx/yy
We figure we've covered everything, but if you need to write anything, here's your chance:
So that's all we need. When you click on SUBMIT you will be taken directly to PAYPAL, and only when this is completed will your details be forwarded to us.

Once you leave this form and progress to paypal, you cannot come back to this form - it will be empty. If for any reason your Paypal transaction does not process, the same applies. (Sorry, this is the system, not our decision)

You will receive a number of confirmations

- one from Paypal that the payment is complete

- when you close that window it will show you a Jotform completion window

- you will receive an email from Jotform showing you the info you sent us

If you've received all this then we have your info, but please don't expect immediate communication from us. Make sure you request to join the CREW Panama FB page. We'll keep you informed as time progresses
Please verify that you are a vitalistic human*
Registration fee - if you felt inclined you can pay a little more to assist in costs*

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USDPlease only pay for one person per registration
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Registration - CREW Panama 2020

The Panamanian Govt requires ALL of the following, and you cannot send us your application unless all 4 are uploaded..

Your Contact Details